What Is Heel Discomfort And Ways To Successfully Treat It

Published on
January 18 2015

Overview

The American College of Sports and Medicine (1) estimates that the average adult takes between 5,000 and 10,000 steps per day. The brunt of this activity is borne by the bones, muscles and ligaments of the foot. Healthy feet have strong, wonderfully flexible ligaments which are designed to support standing, walking and running. Plantar Fasciitis (pronounced "plantar fash-ee-eye-tis") is defined as inflammation of, or damage to, one of the most important ligaments in the foot - the plantar fascia. The plantar fascia ligament is located along the sole of your foot. It is made up of fibrous tissue that stretches outward from the heel bone, like a strong piece of elastic, and then branches out across the arch and through the ball area of the foot toward the toes.

Causes

Plantar fasciitis is common in sports which involve running, dancing or jumping. Runners who overpronate where their feet roll in or flatten too much are particularly at risk the plantar fascia is over stretched as the foot flattens. A common factor is tight calf muscles which lead to a prolonged or high velocity pronation or rolling in of the foot. This in turn produces repetitive over-stretching of the plantar fascia leading to possible inflammation and thickening of the tendon. As the fascia thickens it looses flexibility and strength. Other causes include either a low arch called pes planus or a very high arched foot known as pes cavus. Assessing the foot for plantar fasciitisExcessive walking in footwear which does not provide adequate arch support has been attributed. Footwear for plantar fasciitis should be flat, lace-up and with good arch support and cushioning. Overweight individuals are more at risk of developing plantar fasciitis due to the excess weight impacting on the foot.

Symptoms

The most obvious symptom of plantar fasciitis is a sharp pain on the bottom of the foot, near the heel. Here are some signals that this pain may be plantar fasciitis. The pain is strongest first thing in the morning but gets better after a few minutes of walking around. The pain is worse after standing for a long time or after getting up from sitting. The pain develops gradually and becomes worse over time. The pain is worse after exercise or activity than it is during activity. It hurts when stretching the foot. It hurts when pressing on the sides of the heel or arch of the foot.

Diagnosis

Diagnosis of plantar fasciitis is based on a medical history, the nature of symptoms, and the presence of localised tenderness in the heel. X-rays may be recommended to rule out other causes for the symptoms, such as bone fracture and to check for evidence of heel spurs. Blood tests may also be recommended.

Non Surgical Treatment

If conservative treatments fail, and the symptoms of plantar fasciitis have not been relieved, the doctor may recommend one of the following treatments. Cortisone, or corticosteroids, is medications that reduce inflammation. Cortisone is usually mixed with local anesthetics and injected into the plantar fascia where it attaches to the heel bone. In many cases this reduces the inflammation present and allows the plantar fascia to begin healing. Local injections of corticosteroids may provide temporary or permanent relief. Recurrence of symptoms may be lessened by combining steroid injections with other forms of treatment such as orthotics, changes in shoe gear, weight loss, stretching exercises, and rest. Repeated cortisone injections may result in rupture of the plantar fascia, thinning of the heel's fat pad, and other tissue changes. Extracorporeal Shock Wave Therapy (ESWT) devices generate pulses of high-pressure sound that travel through the skin. For reasons that are not fully understood, soft tissue and bone that are subjected to these pulses of high-pressure energy heal back stronger. There is both a high-energy and low-energy form of ESWT; and both forms of shock wave therapy can be used in the treatment of plantar fasciitis. Research studies indicate ESWT is a safe and effective treatment option for plantar fasciitis. The recovery period is shorter than traditional invasive surgery and the procedure eliminates many of the risks associated with traditional surgery.

Surgical Treatment

The most dramatic therapy, used only in cases where pain is very severe, is surgery. The plantar fascia can be partially detached from the heel bone, but the arch of the foot is weakened and full function may be lost. Another surgery involves lengthening the calf muscle, a process called gastrocnemius recession. If you ignore the condition, you can develop chronic heel pain. This can change the way you walk and cause injury to your legs, knees, hips and back. Steroid injections and some other treatments can weaken the plantar fascia ligament and cause potential rupture of the ligament. Surgery carries the risks of bleeding, infection, and reactions to anesthesia. Plantar fascia detachment can also cause changes in your foot and nerve damage. Gastrocnemius resection can also cause nerve damage.

Stretching Exercises

While it's typical to experience pain in just one foot, massage and stretch both feet. Do it first thing in the morning, and three times during the day. Achilles Tendon Stretch. Stand with your affected foot behind your healthy one. Point the toes of the back foot toward the heel of the front foot, and lean into a wall. Bend the front knee and keep the back knee straight, heel firmly planted on the floor. Hold for a count of 10. Plantar Fascia Stretch. Sit down, and place the affected foot across your knee. Using the hand on your affected side, pull your toes back toward your shin until you feel a stretch in your arch. Run your thumb along your foot--you should feel tension. Hold for a count of 10.